More money won’t win the war on cancer

Written by

Jacoba Urist, The Atlantic

August 28, 2013

The grant system is a giant stop sign for researchers. (Reuters/Mike Blake)

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Written by

Jacoba Urist, The Atlantic

August 28, 2013

Forty-two years after President Nixon signed the National Cancer Act and declared the “war on cancer,” it’s virtually impossible to separate cancer from money—walks, bike rides and pink ribbons entice people to donate more and more. To question the need for more funding to help cancer patients seems almost sacrilege.

But that is what Clifton Leaf, a cancer survivor (diagnosed with Hodgkin’s lymphoma in high school) and an editor at Fortune, asks in his book The Truth In Small Doses: Why We’re Losing The War on Cancer— and How to Win It: What if a lack of research funding isn’t really the problem? One reason we aren’t making faster progress against cancer, according to Leaf, is because the federal grant process often chases the brightest minds from academic labs, and for those who do stay, favors low-risk “little questions” over swinging for the fences.

“More money by itself is not going to solve anything,” Leaf said. “Let’s say we doubled the [National Institutes of Health] budget, that isn’t going to make the lives of researchers better.”

The problem, as Leaf sees it, is with the business of cancer research. Over the last decade or so, “doing science” has reached a crisis stage—a claim many in the cancer community agree with, even if they don’t quite see eye-to-eye with Leaf on all of his conclusions.

For starters, because the National Institutes of Health’s (NIH) funding process has become so protracted and tedious, academic scientists spend too much time worrying about money— thinking about grants, reviewing grants, and finally, managing and administering their active grants in the lab. And all of that is time not spent actually doing cancer research. There’s also, according to Leaf, a mental cost for scientists, in the “hovering uncertainty” that follows even the most seasoned investigators “with stellar resumes and long histories of grant success” when it comes to the future of their work and their laboratories. For example, while the NIH’s budget doubled during the Clinton years, grant applications also doubled, rising from 24,000 in 1998 to nearly 50,000 in 2007, meaning the field was just as competitive from the researcher’s point of view.

“If you are a midcareer investigator,” explained Dr. Otis Brawley, the chief medical officer at the American Cancer Society, “you spend up to half of your time trying to get funding. And that’s a real problem.”

It makes sense for businesses and non-profits to invest significant amounts of time in funding. But academic cancer research is about fighting a disease, not turning a profit or sustaining a charitable mission. We would never, for instance, expect a fire or police department to spend half its time pitching the government for funding—while still fighting fires and saving lives— just to keep its doors open.

To make matter worse, according to Brawley, chances are, the scientists who think outside of the established paradigm aren’t going to get money. As he puts it, the NIH and National Cancer Institute (NCI) are currently “in the business of risk avoidance.”

“The pipeline, or percentage of projects funded, is [less than] 9% by the end of this fiscal year for the NIH and NCI, meaning researchers have less than a 1 out of 10 shot at getting their grant proposal through,” Brawley said. And nobody wants to be accused of taking a big risk and losing. So they end up funding the 9 or 10% [of projects] that they know are going to end up being successful.”

And those lucky 9 or 10% of scientists usually can’t establish independence until sometime in their forties— a problem, Leaf says, “because once you have the freedom and the money to take big risks, you’re likely past your creative prime.” Drawing on the idea that scientists in their twenties and thirties may be the most innovative Leaf argues that too many promising scientists spend their best years in “post-doc purgatory,” trying to get tenure track positions.

“My counterparts in law are already partners and my peers from business school are already CEO’s,” said Dr. E. Ray Dorsey, a 41-year old professor of neurology at the University of Rochester, who also has an MBA in health care management from The Wharton School of the University of Pennsylvania and spent two years at consulting firm McKinsey & Company before his medical residency. Current research funding, he believes, is a terrible economic model. “The best and brightest people either choose not to enter the field of academic research or they can’t stay because of funding issues, so you have more and more scientists leaving for industry, Wall Street, or consulting.”

As he points out, an English professor doesn’t have to fund his own salary. His paycheck comes from students’ tuition and university coffers. Faculty scientists on the other hand, pay themselves a salary from grant money— adding yet more pressure and incentive to exit academic research altogether. “If people had a percentage or base of their salary covered, and didn’t have to fund 100% [of it] on their own, you would see less of the top talent moving into finance or venture capital where the financial rewards are greater,” Dorsey said. “And they would eventually be the chairs of the department.”

Ruth Halaban is a senior research scientist at Yale’s School of Medicine and the director of The Yale SPORE in Skin Cancer, a lab that studies melanoma. She would go so far as to discourage young people from cancer research— including one of her two sons, who, she said, showed an early interest in science—if there’s anything else they might be interested in pursing. The irony is that Halaban is the poster child for success in the current grant system. Last August, the NCI renewed her funding for an additional five years, and $11.5 million, for a specialized center of excellence in melanoma research.

“As a cancer researcher, the future is constantly out of your hands,” Halaban said. “Each grant reviewer wants to see something new, something surprising and fresh, and you can’t do that yourself. You need to get more talent and collaborate with other scientists.”

But collaboration isn’t always easy in a competitive grant structure. Researchers often protect their own turf, pushing for greater funding in their specific area. Brawley, for example, cites lobbies on individual types of cancer, that often advocate for a larger slice of the federal pie for themselves, though that may not be beneficial to cancer science overall— and this beggar-thy-neighbor mentality misses the bigger picture.

“It’s important to remember,” Brawley explained, “that there’s no hard line between research in cancer prevention and cancer treatment, between different types of cancer research, or between industry and academic science.” For instance, Pfizer’s drug Crizotinib was originally intended to treat thyroid cancer. However, academic researchers studying lymphoma identified a defect in a gene that drives a subset of lung cancers and happens to be inhibited by Crizotinib. The result? A new weapon against lung cancer and a prime example of the fluidity of cancer research.

“In the final analysis,” said Susan Higginbotham, the director of research at the American Institute For Cancer Research, which focuses primarily on prevention research, as opposed to the diagnosis and treatment of cancer, “I think we’re just losing a lot of talent because it’s too hard for young scientists to get established.” And if we keep them from asking the right questions, there’s no way we’ll find answers.

Jacoba Urist is a regular contributor to NBCNews and Forbes, where she covers health, lifestyle, and business news.